Devices which have been proposed for the purpose of vaginal examination and gynecological surgical procedures may not be entirely satisfactory for a variety of reasons. In many cases, they may obstruct the vision of the deep internal parts of the vaginal cavity that they are intended to expose. They may also constrain the movement of the physicians' hands and reduce the open work area for the surgeon. This often reduces the efficiency and effectiveness of vaginal examinations and surgical procedures.
Furthermore, typically the vagina walls, the perineum (which is the area of tissue between the vagina and the anus), and the anus are torn during vaginal delivery. Natural perineal tears are classified by their severity. First-degree tears involve tearing only the skin. Second-degree tears involve tearing muscle. Third-degree tears involve tearing the external anal sphincter muscle. Fourth-degree tears further involve tearing the rectal mucosa. When fourth-degree tears occur, the mother may require post-birth surgery to stitch up the torn tissue, often under general anesthetic.
Sometimes the perineum is purposely cut by a doctor performing an episiotomy, which is an incision into the perineum to enlarge the size of the vaginal opening. An episiotomy is similar to a first or second-degree natural tear.
All of the above tearing or incisions usually require post-delivery operations to stitch up the area. Stitching fourth-degree tears is particularly difficult using known specula given that fourth-degree tears typically extend from the vagina wall all the way to the rectum. Such surgery is extremely difficult due to the flaccid nature of the surrounding tissue which exists immediately after birth.
Episiotomy retractors for retracting friable postpartum vaginal tissue to facilitate repair of the episiotomy or vaginal laceration are known. The primary function of the retractor is to provide an open work area for the surgeon about the perineum and posterior vaginal wall of the patient so that the surgeon can conveniently and safely approximate and suture the tissue planes to complete repair.
The known episiotomy retractors may not be entirely satisfactory in use. Existing speculums may not permit access to the area in which the stitching is required and furthermore may tend to interfere with the surgeons ability to make the stitches in the first place.
Most importantly, conventional retractors may fail to provide sufficient open work area for the surgeon about the perineum and the posterior vaginal wall of the patient. During the delivery process the labia of the patient may become engorged with blood and thus may tends to interfere with visualization of the desired work area by the surgeon.
Furthermore, conventional retractors often include scissor arms or other elongated portions for gripping and leverage. However, these elements may increase the size and cost of the devices, and can constrain the movement of the physicians' hands and reduce the open work area for the surgeon.